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Spine J. 2009 Dec;9(12):959-66. doi: 10.1016/j.spinee.2009.05.008. Epub 2009 Jul 1.

Use of polyetheretherketone spacer and recombinant human bone morphogenetic protein-2 in the cervical spine: a radiographic analysis.

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1
Departments of Neurosurgey and Orthopaedic Surgery, 88th Medical Group, Wright-Patterson AFB, OH 45433, USA.

Abstract

BACKGROUND CONTEXT:

Results recently reported in the literature have raised some concerns regarding the use of recombinant human bone morphogenetic protein (rhBMP-2) in the cervical spine.

PURPOSE:

We undertook a radiological and clinical review of cervical fusions performed at our institution with polyetheretherketone (PEEK) interbody cage and rhBMP-2.

STUDY DESIGN:

Observational study.

PATIENT SAMPLE:

Perioperative clinical and radiologic data of all patients who underwent an anterior cervical discectomy and fusion using PEEK and rhBMP-2 for cervical spondylotic radiculopathy or myelopathy were collected.

OUTCOME MEASURES:

Images were examined for fusion, heterotopic ossification, end-plate resorption, subsidence, and segmental sagittal alignment.

METHODS:

All patients underwent detailed postoperative radiologic analysis using a computed tomography (CT) scan obtained at least 6 months postoperatively and plain X-rays obtained at regular intervals.

RESULTS:

Twenty-two patients had 38 levels fused using PEEK and varying doses of rhBMP-2. No anterior cervical swelling requiring additional procedures or longer than anticipated hospital stays occurred. Pseudoarthrosis, shown as a horizontal radiolucent fissure through the midportion of the PEEK cage on CT, occurred in four patients. Excessive bone growth into the spinal canal or foramina occurred in 26 (68%) patients but did not result in neurologic sequelae. Cystic regions in the core of the PEEK spacer were seen in most patients, with 15 levels (39%) having cysts measuring 3mm or greater. Moderate or severe osteolysis of the end plates occurred in 57% of levels, and this led to subsidence of the construct and loss of some of the segmental sagittal alignment (ie, lordosis) that had been achieved with surgery.

CONCLUSIONS:

The unlimited supply of PEEK spacers and rhBMP-2 and their ease of use make them attractive platforms to achieve fusion. This study has demonstrated that the fusion process using rhBMP-2 is a dynamic one, with osteolysis dominating the initial phase, leading to end-plate resorption and consequently loss of some of the disc space height and sagittal alignment that was achieved with surgery. There is a high incidence of bone growth beyond the core of the PEEK spacer and cystic regions within the cage. Given our experience, we currently reserve the use of PEEK and rhBMP-2 for use in those patients who are at greatest risk of pseudoarthrosis.

PMID:
19574105
DOI:
10.1016/j.spinee.2009.05.008
[Indexed for MEDLINE]

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